血清胃蛋白酶原对胃癌癌前病变的诊断价值研究  

The study on the diagnostic value of serum pepsinogens to gastric precancerous lesions

作　　者：张俊旺[1] 甄俊红[2] 师水生[1] 毓珊[1] 王守桃[1] 齐莹[1] 

机构地区：[1]山西医科大学第二医院消化内科,太原030001 [2]山西医科大学第二医院检验科,太原030001

出　　处：《国际肿瘤学杂志》2014年第7期541-545,共5页Journal of International Oncology

摘　　要：目的：通过检测血清胃蛋白酶原在胃黏膜不同病理状态下的表达水平，探讨其作为临床筛查胃癌标志物的可能性及定量范围。方法用时间分辨荧光免疫分析（TRFIA）法检测63例胃黏膜非典型增生、64例慢性萎缩性胃炎、67例胃癌患者和20例健康志愿者血清胃蛋白酶原（PG）Ⅰ、Ⅱ的含量，计算PGⅠ/PGⅡ比值（PGR），并对3类病变进行等级分组，比较PG水平在组间和组内差异。结果①与健康对照组（152．00μg/L）比较，萎缩性胃炎、非典型增生和胃癌患者PGⅠ水平中位数值分别为124．01、91．23和71．23μg/L，差异有统计学意义（Z＝-2．52，P＝0．0170；Z＝-3．42，P＝0．0014；Z＝-3．57，P＝0．0009）。PGR水平M值分别为7．61、5．21和4．32，低于健康组（15．38），差异有统计学意义（Z＝-2．98，P＝0．0029；Z＝-3．17，P＝0．0002；Z＝-2．89，P＝0．0001）；PGⅡ与健康组比较差异无统计学意义（P＞0．05）。②非典型增生和胃癌组血清PGⅠ水平与萎缩组比较差异有统计学意义（Z＝-2．42，P＝0．0024；Z＝-3．62，P＝0．0009）；PGⅡ和PGR水平差异无统计学意义（P＞0．05）。③血清PGⅠ水平在萎缩性胃炎和胃癌组3个级别小组内比较差异无统计学意义（χ2＝2．86，P＝0．4143；χ2＝1．67，P＝0．1368）；而PGⅠ在非典型增生组，轻中度呈下降趋势，重度升高，差异有统计学意义（χ2＝0．83，P＝0．0430），PGⅡ水平和PGR差异无统计学意义（P＞0．05）。④以正常组和胃黏膜非典型增生组的血清PGⅠ和PGR所作的受试者工作特征（ROC）曲线下的面积分别为0．782和0．831；以血清PGI≤72．12μg/L和PGR≤4．32作为临界值筛查胃黏膜非典型增生的敏感性和特异性分别为89．48％和76．31％。结论①随胃黏膜病变严重程度增加，PGⅠ水平和PGR呈下降趋势，PG有可能作为胃黏膜恶性变的筛查标记物。�Objective Toinvestigatethepossibilityandquantitativerangeofpepsinogen（PG）usedas the screening marker of gastric cancer by detecting serum pepsinogen level in different gastric mucous pathologic status.Method ThelevelofserumpepsinogenⅠ（PGⅠ）andpepsinogenⅡ（PGⅡ）bytimeresolvedfluoro-immunoassay（TRFIA）in 64 chronic atrophic gastritis patients,63 gastric mucous atypical hyperplasia patients, 67 gastric cancer patients and 20 healthy volunteers were defeeted ,and the ratio of PGR（PGⅠ/PGⅡ）was calculated.Then the three kinds of diseases were graded.The data was analyzed between groups and sub-groups.Result ①Compared with normal control group,the median PGⅠvalues were 1 24.01 ,91 .23 and 71 .23 respectively,which were all lower than that of healthy group （1 52.00）.There were significant differ-ences（Z=-2.52,P=0.01 7 0;Z=-3.42,P=0.001 4;Z=-3.57,P=0.000 9）.The median PGR values were 7.61 ,5.21 and 4.32 respectively,which were also lower than that of healthy group,the differences were significant（Z=-2.98,P=0.002 9;Z=-3.1 7,P=0.000 2;Z=-2.89,P=0.000 1 ）.The PGⅡlevel of these diseases were not significantly different with control group.②The serum PGⅠlevel of gastric mucous＆amp;nbsp;atypical hyperplasia and gastric cancer were reduced significantly in contrast with atrophic gastritis （Z =-3.42,P =0.001 4;Z=-3.62,P=0.000 9）;the levels of PGⅡand PGR were varied without significance （P〉0.05 ）;③The levels of PGⅠamong atrophy gastritis and gastric cancer subgroup have no significant difference（χ2 =2.86,P=0.41 4 3;χ2 =1 .67,P=0.1 36 8）.But the level of PGⅠwas significantly different in gastric atypical hyperplasia（χ2 =0.83,P=0.043 0）.It decreased in light and medium grade dysplasia and went up in severe grade dysplasia.The levels of PGⅡ and PGR were varied without significance（P〉0.05）.④The areas under the ROC curves performed by the PGⅠ and PGR from normal control group and atypical hyperplasia group were 0.782 and 0.831 respectively;The se

关 键 词：胃蛋白酶原类 萎缩 癌前状态 荧光免疫测定 

分 类 号：R735.2[医药卫生—肿瘤]